Madhu C. Reddy

A model for understanding collaborative information behavior in context: A study of two healthcare teams

Collaborative information behavior is an essential aspect of organizational work; however, we have very limited understanding of this behavior. Most models of information behavior focus on the individual seeker of information. In this paper, we report the results from two empirical studies that investigate aspects of collaborative information behavior in organizational settings. From these studies, we found that collaborative information behavior differs from individual information behavior with respect to how individuals interact with each other, the complexity of the information need, and the role of information technology. There are specific triggers for transitioning from individual to collaborative information behavior, including lack of domain expertise. The information retrieval technologies used affect collaborative information behavior by acting as important supporting mechanisms. From these results and prior work, we develop a model of collaborative information behavior along the axes of participant behavior, situational elements, and contextual triggers. We also present characteristics of collaborative information system including search, chat, and sharing. We discuss implications for the design of collaborative information retrieval systems and directions for future work.

Collaborative information seeking: A field study of a multidisciplinary patient care team

Multidisciplinary teams are an essential aspect of modern organizational work. These teams often work in information-rich environments but little is known about their collaborative information seeking (CIS) behavior. We have been studying the CIS behavior of teams in the context of medical care. We conducted an ethnographic field study of a multidisciplinary patient care team in an emergency department to identify (a) team information needs and (b) situations that trigger collaborative information seeking activities. We identified seven categories of information needs as expressed by questions asked by team members. The majority of questions focused on medical information, but there were a larger than expected percentage of questions focusing on organizational information. We also identified three triggers for CIS activities. These triggers are: (1) lack of expertise, (2) lack of immediately accessible information, and (3) complex information needs. The questions and triggers highlight the importance of face-to-face communication during CIS activities and how CIS activities could lead to interruptive workplaces. We also discuss organizational and technical implications for supporting CIS behavior of teams.

Coordinating heterogeneous work: information and representation in medical care

Medical care involves intense collaboration amongst a number of practitioners including physicians, nurses, and pharmacists Their work is concentrated on a single patient, and yet their activities, motivations, and concerns are very different. We explore the use of a shared information system in helping these individuals coordinate their work. In particular, we use the idea of a common information space to explore how the shared information is incorporated into the diverse work practices of an intensive care unit. In addition to physical co-location, we found that providing information in many specialised representations is critical to managing their coordination. Unlike paper records, computer systems offer the ability to decouple information from its representations. This decoupling opens up a rich design space for systems that allow people with different interests, concerns and work practices to work together effectively.

Incorporating ideas from computer-supported cooperative work

Many information systems have failed when deployed into complex health-care settings. We believe that one cause of these failures is the difficulty in systematically accounting for the collaborative and exception-filled nature of medical work. In this methodological review paper, we highlight research from the field of computer-supported cooperative work (CSCW) that could help biomedical informaticists recognize and design around the kinds of challenges that lead to unanticipated breakdowns and eventual abandonment of their systems. The field of CSCW studies how people collaborate with each other and the role that technology plays in this collaboration for a wide variety of organizational settings. Thus, biomedical informaticists could benefit from the lessons learned by CSCW researchers. In this paper, we provide a focused review of CSCW methods and ideas-we review aspects of the field that could be applied to improve the design and deployment of medical information systems. To make our discussion concrete, we use electronic medical record systems as an example medical information system, and present three specific principles from CSCW: accounting for incentive structures, understanding workflow, and incorporating awareness.

Temporality in Medical Work: Time also Matters

CSCW has long been concerned with the distribution of activities in time and in space, but the problems of distributed work have often taken analytic and technical precedence. In this paper, we are interested in the issue of temporality in collaborative work. In particular, we want to examine how the temporal organization of action is experienced by those who are involved in it. To investigate this phenomenon, we conducted a field study of medical workers in a surgical intensive care unit. Through this study, we highlight the temporal organization of the work. In particular, we introduce and describe three temporal features – temporal trajectories, temporal rhythms, and temporal horizons – that emerge from and influence the work of healthcare providers as they attempt to seek, provide, and manage information during the course of their daily work.

Understanding together: sensemaking in collaborative information seeking

An important aspect of collaborative information seeking (CIS) is making sense of the information found, i.e., collaborative sensemaking. We conducted an ethnographic study of the CIS practices of healthcare providers in a hospital emergency department to gain a conceptual understanding of when and how collaborative sensemaking occurs during CIS activities. We present occasions and characteristics of collaborative sensemaking and design implications for collaborative information retrieval tools to support sensemaking.

Challenges to effective crisis management: Using information and communication technologies to coordinate emergency medical services and emergency department teams

OBJECTIVE The purpose of this study is to identify the major challenges to coordination between emergency department (ED) teams and emergency medical services (EMS) teams. DESIGN We conducted a series of focus groups involving both ED and EMS team members using a crisis scenario as the basis of the focus group discussion. We also collected organizational workflow data. RESULTS We identified three major challenges to coordination between ED and EMS teams including ineffectiveness of current information and communication technologies, lack of common ground, and breakdowns in information flow. DISCUSSION The three challenges highlight the importance of designing systems from socio-technical perspective. In particular, these inter-team coordination systems must support socio-technical issues such as awareness, context, and workflow between the two teams.

A Systematic Review of Simulation Studies Investigating Emergency Department Overcrowding

The problem of emergency department (ED) overcrowding has reached crisis proportions in the last decade. In 2005, the National Academy of Engineering and the Institute of Medicine reported on the important role of simulation as a systems analysis tool that can have an impact on care processes at the care-team, organizational, and environmental levels. Simulation has been widely used to understand causes of ED overcrowding and to test interventions to alleviate its effects. In this paper, we present a systematic review of ED simulation literature from 1970 to 2006 from healthcare, systems engineering, operations research and computer science publication venues. The goals of this review are to highlight the contributions of these simulation studies to our understanding of ED overcrowding and to discuss how simulation can be better used as a tool to address this problem. We found that simulation studies provide important insights into ED overcrowding but they also had major limitations that must be addressed.

Paging “Dr. Google”: Does Technology Fill the Gap Created by the Prenatal Care Visit Structure? Qualitative Focus Group Study With Pregnant Women

Background The prenatal care visit structure has changed little over the past century despite the rapid evolution of technology including Internet and mobile phones. Little is known about how pregnant women engage with technologies and the interface between these tools and medical care, especially for women of lower socioeconomic status. Objective We sought to understand how women use technology during pregnancy through a qualitative study with women enrolled in the Women, Infants, and Children (WIC) program. Methods We recruited pregnant women ages 18 and older who owned a smartphone, at a WIC clinic in central Pennsylvania. The focus group guide included questions about women’s current pregnancy, their sources of information, and whether they used technology for pregnancy-related information. Sessions were audiotaped and transcribed. Three members of the research team independently analyzed each transcript, using a thematic analysis approach. Themes related to the topics discussed were identified, for which there was full agreement. Results Four focus groups were conducted with a total of 17 women. Three major themes emerged as follows. First, the prenatal visit structure is not patient-centered, with the first visit perceived as occurring too late and with too few visits early in pregnancy when women have the most questions for their prenatal care providers. Unfortunately, the educational materials women received during prenatal care were viewed as unhelpful. Second, women turn to technology (eg, Google, smartphone applications) to fill their knowledge gaps. Turning to technology was viewed to be a generational approach. Finally, women reported that technology, although frequently used, has limitations. Conclusions The results of this qualitative research suggest that the current prenatal care visit structure is not patient-centered in that it does not allow women to seek advice when they want it most. A generational shift seems to have occurred, resulting in pregnant women in our study turning to the Internet and smartphones to fill this gap, which requires significant skills to navigate for useful information. Future steps may include developing interventions to help health care providers assist patients early in pregnancy to seek the information they want and to become better consumers of Internet-based pregnancy resources.

Challenges to inter-departmental coordination of patient transfers: A workflow perspective

OBJECTIVE The purpose of this study is to identify challenges to inter-departmental coordination activities that affect patient transfer workflow and to provide socio-technical requirements for the design of technologies to better support patient transfer workflow. DESIGN We conducted our study in two clinical and one non-clinical department at a major academic hospital. We utilized qualitative data collection techniques including observations of patient transfer practices of the different departments and interviews with departmental staff to collect data on the inter-departmental coordination activities and its effect on patient transfer workflow. RESULTS We identified three inter-departmental challenges that affected the patient transfer workflow: ineffective inter-departmental interactions, ineffective information handoffs, and ineffectiveness of current information technologies. DISCUSSION To address these challenges, we discuss three socio-technical design requirements that designers need to pay attention to while developing inter-departmental healthcare information systems. To ensure effective inter-departmental coordination, the systems should incorporate features that can support the mediating role of integrators, the collaborative balancing of goals, and the collaborative prioritization of resources.